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Newcastle upon Tyne Area Child Protection
PARENTAL SUBSTANCE MISUSE AND THE EFFECTS
ON CHILDREN
Practice guidance for agencies in contact with children and
young people
October 2002
The following policy statement has been adopted by Newcastle Area Child
Protection Committee
‘Every agency working with children and
families should be aware that children
cared for by adults who misuse
substances may need to be considered
within the framework of children in need.
In addition, it may be necessary, having
regard to the lifestyle imposed on
children by such adults, to consider them
as children at risk of significant harm and
therefore in need of protection’
All agencies should therefore, seek to
intervene to act to safeguard and
promote the welfare of children in such
situations.
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Contents
1. Introduction
2. Definitions
3. Key themes
4. Facts and figures
5. Confidentiality and consent
6. Effects of substance misuse on individuals
7. Parental substances misuse and the effects on children
8. Substance misuse in pregnancy
9. Babies born to substance misusing parents
10. Assessing risk – crossing the Child Protection threshold
11. Responsibilities of professionals
12. Inter-agency partnership
13. References
Appendix 1
Effects of Substances
Appendix 2
SCODA Guidelines
Appendix 3
Framework for the Assessment of Children and their Families (DOH
2000)
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1.
INTRODUCTION
This guidance has been developed for practitioners in Newcastle working with children
and families and/or adults who have care of children where substance misuse is a factor,
which affects their lives. It has been produced in response to the increasing problem of
substance misuse and particularly the rising number of children who are referred into the
child protection arena due to parental substance misuse. Following the death of 3
children in separate families in Newcastle where substance misuse was a fac tor, the
ACPC has recognised that the link between substance misuse and a person’s ability to
act as a responsible parent is not always clear. The guidance therefore aims to provide
practitioners with information about the issue of substance misuse and how this may
impact upon an individual’s ability to care for a child. The guidance is intended as a risk
management tool for professionals, directing them in their practice when assessing if, or
how a parent or carer misusing substances is affecting a child.
The guidance has been developed by Newcastle Area Child Protection Committee and
should be read in conjunction with the ACPC Child Protection Procedures “Working
Together to Safeguard Children in Newcastle” (2001), and Newcastle “Frame- work
for the Assessment of Children” Inter-agency Procedures (2002)
It is acknowledged that not all substance users have problems with parenting. However
in many cases it will be necessary to make an assessment, which includes the
substance use and behaviour of the parents, and any impact from this upon their
parenting, before deciding what help, if any, is required, and whether child protection
procedures should be initiated.
These guidelines are intended to help with this
assessment and decision making process.
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2. DEFINITIONS
Parent – is defined so as to include any person who is not a parent of a child but has
parental responsibility for them or has care of them.
Child in Need – A child i.e. a person under 18 years is in need if they are unlikely to
achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable
standard of health and development without the provision of services by a local
authority.
Significant Harm – There is no absolute criteria on which to rely when judging what
constitutes significant harm. Consideration of the severity of ill-treatment may include
the degree and the extent of the physical harm, the duration and frequency of abuse and
neglect, and the extent of premeditation, degree of threat and coercion, sadism, and
bizarre or unusual elements in child sexual abuse. (Ref: pages 7 & 8 Working Together
1999)
Substance - Refers to illicit and prescribed drugs, alcohol and solvents.
Misuse - Refers to consumption of substances which is either dependent use or use
associated with having a harmful effect on the individual or the community.
3. KEY THEMES UNDERPINNING THIS GUIDANCE
a. Recognition that many parents whom misuse drugs and/or alcohol are good
enough parents.
b. Professionals need to assess the effects of substance misuse upon an
individual’s ability to maintain consistent and adequate care for a child.
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4. FACTS AND FIGURES
Information obtained from University of Manchester re Newcastle DAT area
Age/Sex Profile of people who misuse substances including alcohol
Age Group
< 15 years
Male
%
Female
%
Total
%
7
0.8
0
0.0
7
0.6
15 – 19
63
7.1
22
8.7
85
7.4
20 – 24
170
19.1
51
20.1
221
19.3
25 – 29
181
20.3
48
18.9
229
20.0
30 – 34
151
16.9
29
11.4
180
15.7
35 – 39
94
10.5
32
12.6
126
11.0
40 – 44
80
9.0
25
9.8
105
9.2
45 – 49
66
7.4
18
7.1
84
7.3
50 – 54
42
4.7
15
5.9
57
5.0
55 – 59
21
2.4
12
4.7
33
2.9
60 – 64
11
1.2
2
0.8
13
1.1
5
0.6
0
0.0
5
0.4
= 65year
Totals
891
254
1,145
Drugs only
Age Group
< 15 years
Male
7
%
Female
1.6
0
%
Total
%
0.0
7
1.3
16.8
65
11.8
15 – 19
46
10.5
19
20 – 24
114
26.1
39
34.5
153
27.8
25 – 29
127
29.1
25
22.1
152
27.6
30 – 34
81
18.5
14
12.4
95
17.3
35 – 39
25
5.7
7
6.2
32
5.8
40 – 44
20
4.6
4
3.5
24
4.4
45 – 49
10
2.3
2
1.8
12
2.2
50 – 54
4
0.9
1
0.9
5
0.9
55 – 59
3
0.7
2
1.8
5
0.9
60 – 64
0
0.0
0
0.0
0
0.0
= 65 year
0
0.0
0
0.0
0
0.0
Totals
437
113
550
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Drug Groups – Main Drug
Drug
Number
%
Male
Female
Inj
Valid %
~ Age
326
28.5
250
76
76
39.0
27.0
Methadone
16
1.4
13
3
0
0.0
31.2
Other Opiates
11
1.0
5
6
1
14.3
36.0
Benzodiazepines
33
2.9
29
4
0
0.0
34.8
Amphetamines
28
2.4
19
9
4
33.3
30.4
Cocaine
27
2.4
24
3
2
13.3
30.2
2
0.2
1
1
0
0.0
22.3
Ecstasy
10
0.9
9
1
0
0.0
24.1
Cannabis
72
6.3
65
7
0
0.0
24.6
Solvents
6
0.5
6
0
0
0.0
28.8
Barbiturates
2
0.2
2
0
0
0.0
28.3
Major Tranx
0
0.0
0
0
0
0.0
0.0
Anti-depressants
6
0.5
5
1
0
0.0
29.8
602
52.6
460
142
0
0.0
37.9
Other Drugs
4
0.3
3
1
1
50.0
28.2
Poly Use, No Details
0
0.0
0
0
0
0.0
0.0
Drug free & no drugs given
0
0.0
0
0
0
0.0
0.0
891
254
84
Heroin
Hallucinogens
Alcohol
Totals
1,145
5. CONFIDENTIALITY AND CONSENT
a.
Confidentiality is a major factor in developing trust and in building and
sustaining relationships between families and professionals. All agencies
should have written procedures on confidentiality.
b.
As no agency can guarantee absolute confidentiality, staff should explain
their agency’s policy and need for appropriate information sharing with
parents who misuse substances, particularly when there is concern that
the individual is putting someone else at risk, such as a child.
If a professional identifies a concern regarding a child’s welfare, they
should inform their client of the concern and discuss with them the reasons
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for this (except where telling the client may result in harm to a child or
themselves, in which case, the professional should discuss the situation
with their line manager first). The professional should seek their client’s
consent to refer for help from other services/agencies. If this consent is
not given, and the professional believes the child is at risk of significant
harm, they should override the parents’ wishes. (Ref: DOH Framework for
the Assessment of Children in Need and their Families 2000)
6. EFFECTS OF SUBSTANCE MISUSE ON INDIVIDUALS
All substance misuse is potentially harmful and most types of use carry health risks. The
use of drugs, alcohol and solvents can result in accidents, unsociable behaviour, crime
and health problems including poisoning or overdose. Use of certain substances, for
example, heroin and crack is associated with a greater potential to cause harm due to
both greater health risks and greater social risks, such as acquisitive crime.
Some methods of use are more harmful than others, for example, intravenous use, as
this can lead to the transmission of blood born disease such as HIV and Hepatitis (see
Appendix 1). Furthermore, some patterns of use are more harmful than others, these
include:
•
Dependent use - A compulsion to continue to use a substance in order to
feel good or avoid feeling bad.
When this is done to avoid physical
discomfort it is known as physical dependence, when it is used to avoid
anxiety or mental stress or promote stimulation or pleasure, it is known as
psychological dependence.
•
Combination use - The use of more than one substance, for example, use of
drugs and alcohol or the use of more than one drug.
•
Chaotic and unrestrained use - Linked with combination use or bingeing on
a single drug until the supply runs out or exhaustion or heavy intoxication
prevents further use.
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Substance misuse can affect an individual, and consequently their families, in very
different ways . The effects of the substance misuse will vary according to:
•
The individual
•
The physical and psychological state – including whether the individual is on
prescribed drugs for mental health problems.
•
The substance used and the methods of use.
•
The circumstances in which the substance is used.
•
Where use takes place and the presence of other people at these times.
See Appendix 1 for a summary of the effects of different substances on users.
7. PARENTAL SUBSTANCES MISUSE AND THE EFFECTS ON CHILDREN
Agencies working with substance misusing parents should recognise that children are
not necessarily at risk just because a parent uses substances.
Many children of
substance misusing parents receive good parenting, stability and have all their needs
fully met. However, agencies working with children should be alert to the possibility that
substance misuse by a parent may lead to a child being considered as a child in need,
and may prevent a child from receiving the level and quality of care that they need.
‘There is a reasonable basis in research to suggest that a child whose parent is misusing
substances is at increased risk. Substance misuse can demand a significant proportion
of a parent’s time, money and energy, which will unavoidably reduce resources available
to the child. Substance misuse may also put the child at an increased risk of neglect
and emotional, physical or sexual abuse, either by the parent or because the child
becomes more vulnerable to abuse by others.’
(V Lewis 1997)
Children’s physical, emotional, social, intellectual and developmental needs can be
adversely affected by their parent’s misuse of substances.
These affects may be
through acts of omission or commission, which have an impact on the child’s welfare
and protection.
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Children may be at risk of physical harm in terms of:
•
Access to drugs or drugs paraphernalia within the home, for example tablets,
needles etc.
•
The use of alcohol and/or some drugs can act as a disinhibitor that allows
violence to surface or lowers tolerance levels.
•
Children may be exposed to a number of strangers within the home who may
be potentially dangerous to the child. Where families are entrenched in the
drug culture, this may include, for example, threats of violence or demanding
money and menaces within the home.
•
Substance use during pregnancy may result in chemical dependence for the
child when s/he is born and/or other associated health risk factors.
Children of substance misusing parents may be at risk of having their needs neglected,
as dependency on the substance may become the central organising influence of the
family, overpowering many parents’ strengths and competencies. Therefore, for some
parents who use alcohol, drugs and/or solvents, their ability to meet some or all of their
children’s needs may be diminished. Some concerning factors may be:
•
The child’s basic physical needs not being adequately met.
•
The child receives inadequate supervision for their age.
•
Health appointments for the child are not kept or appropriate advice is not
sought for any health problems the child may be experiencing.
•
Disruption to the child’s education or poor school attendance.
•
Child’s own needs are not being acknowledged or are ignored by their
caregiver.
•
Unrealistic expectations of a child’s abilities.
•
No clear boundaries between family roles with the child assuming a parental
role.
•
Lack of boundaries and routines for the child.
Substance misuse may have an impact on a child’s emotional well being as a result of
their emotional needs not being met, however, there are other factors which can also
affect a child’s emotional well-being, for example, it may be that parents under the
influence of substances are emotionally unavailable to their child.
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Parents under the influence of alcohol and/or drugs can be very frightening to a child.
The child may emotionally affected by living with a parent who has:
Severe mood swings
Hallucinations
Withdrawal symptoms
Where parental substance misuse in a home affects a child, the child is likely to be in
tune with their parent/s’ need for drugs and/or alcohol and respond by removing itself
from potentially volatile or abuse situations.
In addition, the child’s daily life may involve a great deal of emotional stress in terms of:
Fearing they may be abandoned.
Fearing that their parent/s may die.
Being afraid their parent/s do not love them.
Being afraid other people may find out about their parents substance misuse.
Feeling responsible for their parent/s misuse.
Children who live with these daily stresses may present as sad, unhappy and withdrawn.
Their own self-esteem may well be affected as they feel they have no control over
events within their own lives. Research cited in Dore, Doris and Wright (1995) suggests
that children who live with substance misusing parents as part of their everyday life, may
run a higher risk of having mental health problems themselves, a greater rate of drug
and alcohol use in adolescence, impaired intellectual and academic functioning, higher
levels of anxiety and depression and lower self-esteem.
These children may feel
different from other children and may worry that their friends may find out about their
parents/substance misuse. Therefore, they may miss out on aspects of childhood many
children take for granted, for example, having friends visit them at home.
There is no research, which indicates there is a significant link between substance
misuse and child sexual abuse. However, as indicated earlier, use of substances may
act as a disinhibitor and allow abusive behaviour to take place or a child may be
exposed to strangers within the home who may present a risk to them.
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8. SUBSTANCE MISUSE IN PREGNANCY
General Information
Twenty five per cent of people seeking help for drug problems are female and 90% of
female drug users in treatment are of reproductive age. There are increasing numbers
of women using illicit drugs being notified to midwifery and obstetric services. Women
taking substances especially those taking opiates, can have reduced fertility and
irregular or absent periods. Many of these women believe that they cannot become
pregnant and consequently may not use contraception. It is often a shock for them to
discover they are pregnant. A number of women do not seek antenatal care until late in
the pregnancy or when they are in labour, as some will not seek appropriate care for
themselves or their unborn child due to an anxiety regarding the response of
professionals to their substance misuse, and fear the attitudes of professionals and the
involvement particularly of Social Services.
Treatment Centres
Women who are attending substance abuse treatment services usually use antenatal
services more appropriately and have better general health than substance misusers
who are not in treatment, even if they are still using drugs. It is important to note that the
risks involved in stopping suddenly can be high and cause problems to both the mother
and baby. Therefore it is essential that pregnant women seek medical advice before
they stop taking any substance.
Health Risks To Infants
Substance misuse by a pregnant woman may affect the foetus adversely and lead to a
range of problems, including low birth weight and/or premature birth.
A newborn baby
may also develop withdrawal symptoms and require medication or other treatment.
However it should be noted that the babies of alcohol or drug using mothers might be ill
for reasons unconnected with their substance misuse. If the newborn baby is sick it may
strain the mother’s already compromised parenting skills.
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9. BABIES BORN TO SUBSTANCE MISUSING PARENTS
Ensuring that vulnerable pregnant substance misusers receive appropriate antenatal
care and support to maximise both their own and their expected baby’s health and well
being is a task shared by all those involved. In many cases where pregnant women are
substance-misusing, health professionals or workers from voluntary agencies will be the
first to be involved.
The North of Tyne Antenatal Group has devised practice guidelines for managing
pregnant women who misuse substances, and convene meetings at 28 and 32 weeks
gestation as an information sharing and monitoring process. Health staff in Newcastle
upon Tyne are currently using these guidelines.
The Community Midwife may refer pregnant women who misuse substances to Social
Services for an initial assessment. A referral may also be necessary if the partner of a
pregnant woman misuses substances, although professional judgement on individual
cases will need to be exercised.
If a referral is made to Social Services the principles of inter-agency assessment and
working will apply, as provided by the Framework for the Assessment of Children
and their Families (DOH 2000) (see appendix 3), and which is incorporated within
Newcastle Framework for the Assessment of Children Inter-agency Procedures
(2002)
If there is a need for ongoing involvement after initial assessment the identified social
worker will attend meetings held by health professionals at 28 and 32 weeks gestation.
If child protection procedures are initiated, these meetings should run parallel. Social
Services will also contribute to a pre-discharge multi-disciplinary discussion between
hospital and community based professionals, which will take place to ensure there is a
common understanding of the baby’s health and social needs.
It is recognised that the period between 0-3 months after the birth of the baby is a crucial
time for women who are opiate dependent and may result in a change in substance
misuse, which could have an impact on the care of the baby. This will need to be
considered as part of the on going assessment.
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10. ASSESSING THE RISK – CROSSING THE CHILD PROTECTION THRESHOLD
Focussing on the Child
In undertaking an assessment of the impact of substance misuse on parenting capacity,
it is crucial to maintain the focus on the needs of the child and their welfare at all times.
It is important to consider the parental substances misuse from the perspective of the
child and the impact it has on the child’s life and development. It is also necessary to
separate the effects of substance use on the family from the effects on each individual
child in the family. Professionals need to identify services that can reduce any adverse
effects on the child of parental substance misuse.
For some children, parental substance misuse will affect their lives to such an extent that
they become children who are in need of protection.
In considering whether the child protection threshold is crossed, professionals should
give consideration to the following factors:
Is the child receiving adequate and consistent care?
Are the parent/s meeting the child/s physical, emotional, social, intellectual and
developmental needs?
Is the child’s home a safe place?
Are there a lot of strangers in the house as a result of illicit drug use?
Is appropriate medical care sought for the child when required?
Does the parent/s substance misuse involve them in other activities, for example
selling drugs, prostitution and/or offending?
Are sufficient finances available to ensure the child’s needs are met?
Does the child attend Nursery/ School regularly?
Do the child and parent have a positive relationship?
Are there only substance using adults in the household?
Are there other substance using adults in the household?
Is there an absence of supportive family members or other support networks?
Are the parent/s placing their own needs above those of the child?
Is there a history of poor parenting?
Are there other factors, which may increase the risk, for example, domestic violence?
For unborn babies, has appropriate antenatal care been sought?
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Is the child given inappropriate responsibilities in the home, for example, self care,
parental children, looking after siblings, managing household chores etc?
Are the children frightened of their parent/s or witnessing or experiencing frightening
things within the home, for example severe mood swings by their parent/s,
hallucinations etc?
Do the parent/s deny that substance use is a problem for themselves and their
children?
Are there clear and appropriate boundaries within the home?
What are the effects of the substance misuse on the parent/s i.e. any evidence of
thought disorder, paranoia, hallucinations or bizarre behaviour?
These factors in isolation are not indicative of abuse and/or neglect and the list is not
exhaustive.
However, consideration of these factors ensures that the focus of the
professionals is on the impact of substance misuse upon childcare rather than the
parent/s’ use itself.
At any stage, should there be concern that the child may be or is likely to suffer
significant harm; there must be strategy discussions and inter-agency action in line with
Newcastle ACPC Procedures. The criteria for deciding whether a child is at risk and
therefore in need of protection should be the same for all children. Assessment of what
is happening to the child in these circumstances is not a separate process, although the
pace and scope of assessment will be to establish whether there is reasonable cause to
suspect that the child is suffering or is likely to suffer significant harm and whether any
emergency action is required to secure the safety of the child.
Where professionals identify that a child is suffering or likely to suffer significant harm as
a result of parental substance misuse, they should follow child protection procedures to
ensure a referral is made to the Social Services Directorate.
As with all cases of
suspected child abuse and/or neglect, these procedures should be followed to ensure
the protection of the child.
Where a professional is unsure whether or not to make a child protection referral, they
should seek advice from child protection professionals within their own agency or
contact the Duty Social Work Team to discuss their concerns and agree what action, if
any, should be taken.
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11. RESPONSIBILITIES OF PROFESSIONALS
As workers we are likely to come across substance misuse within families and it is
important that any areas of risk are recognised at an early stage so that intervention and
services needed can be offered appropriately.
Where it comes to the attention of any professional that a parent is misusing substances,
a process of information gathering should take place to inform a preliminary risk
assessment. This process should be informed by talking with the parent about their
substance use to establish the nature and extent of it, and to clarify what other agencies
are involved with the family, for example, health, education, social services, probation
service etc. Professionals should be open and honest regarding why they require this
information.
It may be, that at the end of this process, no concerns are identified regarding the
welfare of any children within the family. In such circumstances, professionals should
continue to provide their services to the individual or family. Be mindful however that the
situation could alter in a very short space of time and therefore it is necessary to
continuously monitor the child and/or family circumstances.
Where it is identified that the child’s situation meets the criteria of a child in need,
including a child in need of protection, a referral should be made to Social Services.
12. INTER-AGENCY PARTNERSHIP
Protecting children can be successful if the professional staff concerned do all they can
to work in partnership and share and exchange relevant information. It is important that
professionals from all agencies working with an adult who has care of a child, and
professionals from child care agencies, work collaboratively, sharing knowledge and
expertise.
Agencies have a collective responsibility to protect children. This demands effective
communication and co-ordination of services at both strategic and operational levels.
Professionals have a shared responsibility to arrange appropriate packages of support
for vulnerable families.
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The effectiveness of working with vulnerable families can be greatly enhanced by good
inter-agency communication and co-operation.
All agencies need to work together in partnership with parents.
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13. BIBLIOGRAPHY
Children Act 1989
Department of Health (1999): Working Together to Safeguard Children: A guide to
inter-agency working to safeguard and promote the welfare of children.
Department of Health (2000): Framework for Assessing Children in Need and their
Families.
Cleaver H (1999): Children’s Needs – Parenting Capacity
Horwath J (2001): The Child’s World – Assessing Children in Need
Camden Practice guidelines re: parental substance misuse
Middlesborough Practice Guidelines re: parental substance misuse
Manchester University – statistical information
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Appendix 1
EFFECTS OF SUBSTANCES
Alcohol
Alcohol is a central nervous system depressant, which encourages disinhibition. The
short term effects of alcohol use includes intoxication (leading to accidents, aggression
etc), poor co-ordination, vomiting, drowsiness, slurred speech, loss of consciousness,
respiratory depression and death.
Prolonged misuse of alcohol can result in physical
health problems (for example, liver cirrhosis, alcoholic hepatitis, liver cancer etc)
malnutrition, depression, memory loss and blackouts.
Alcohol use can lead to
psychological and physical dependence.
Use during pregnancy:
Binge drinking and continued heavy drinking, especially in the first twelve weeks of
pregnancy, may cause ‘foetal alcohol syndrome’. This can present as retardation and
slow physical growth, however this is rare. Alcohol does affect breast milk and can lead
to sedation and lethargy in the infant.
Amphetamine (slang terms: Whizz, Speed)
Amphetamine is a popular stimulant drug, which stimulates the nervous system and
keeps the user awake and energetic, it is sometimes used to suppress the appetite.
Amphetamine usually appears as a white or greyish powder (amphetamine sulphate),
which is usually sniffed or injected.
There are also pills or capsules produced for
medical use, which are generally swallowed.
For some people even moderate use of amphetamine can result in a condition known as
‘amphetamine psychosis’ which is characterised by excessive mood swings, irritability,
confusion and sometimes bouts of violent behaviour. The mental disorder or ‘psychosis’
usually passes when the drug is stopped but there remains a danger that those with
latent mental conditions could have this condition triggered by use of amphetamines.
Tolerance to amphetamines develops quickly, leading to a rapid increase in use.
Anxiety, depression, paranoia and weight loss are common side effects of the drug.
19
Use during pregnancy:
Amphetamine use during pregnancy, especially in the first three months has been linked
with miscarriage, premature labour and low birth weight. Cases of cleft palate and heart
deficiencies have also been reported. Amphetamine use causes increased heart rate,
blood pressure and respiration as well anorexia, weight loss and insomnia in the mother,
these may result in decreased blood flow to the placenta. Newborn babies may have
symptoms of withdrawal, for example, agitation, and poor feeding. Amphetamines can
be found in breast milk causing irritability, poor feeding and sleep disturbance.
Benzodiazepines (Slang terms: eggs, jellies, benzo)
Benzodiazepines are minor tranquillisers, which include temazepam, diazepam,
nitrazepam and lorazepam. They are the most commonly prescribed drugs in Britain
and therefore are readily available on the illicit market. Benzodiazepines are pills or
capsules, which are usually swallowed, however, they can be ground down and injected.
The effects of benzodiazepines are to relieve anxiety and promote sleep. Tolerance can
develop with frequently repeated doses.
Use during pregnancy:
There are links between using benzodiazepines in the first 12 weeks of pregnancy and
the mouth defect known as ‘cleft palate’.
Benzodiazepines cross the placenta and
therefore, the baby may become addicted. Symptoms include disturbed sleep, twitching,
convulsions and shaking which can last for up to eight months, depending on the
mother’s level of use. Benzodiazepines are also found in breast milk and can cause the
baby to be difficult to feed and become drowsy. However, IT IS IMPORTANT NOT TO
STOP USE SUDDENLY as this could lead to premature labour and acute withdrawal in
both mother and baby.
Cannabis (Slang terms: dope, blow, hash, grass, ganja)
Cannabis is derived from a leafy plant, it can be bought as leaves, stalks and seeds,
known as grass or in a solid brown lump, known as hash. It is usually smoked, often
with tobacco in the form of ‘joints’ or ‘spliffs’ or can be smoked by itself in a pipe. It can
also be eaten with food or brewed in a drink. It is the most widely used illegal drug in
Britain.
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The effects of cannabis can depend largely on the mood or expectations of the user and
vary from relaxation to being talkative, bouts of hilarity and greater appreciation or
stimulus. However, if someone were depressed or anxious, it would make him or her
feel worse. Cannabis can affect short-term memory and concentration. There is no
conclusive evidence that cannabis causes lasting damage to physical or mental health.
It is not physically addictive, but a psychological dependency can develop.
Use during pregnancy:
Tetrahydrocannabinol (THC), the most powerful substance in cannabis can cross the
placenta and is found in breast milk. There is some evidence of lower birth weight and
premature birth of the baby, however this may be linked with nicotine use.
Cocaine and Crack (Slang terms: coke, rock, Charlie)
Cocaine is a white stimulant power, which is sniffed or injected.
Cocaine is usually
impure and adulterated with other substances, which can be harmful. ‘Crack’ is a more
pure form of cocaine in the form of small ‘rocks’ or crystals, which is usually smoked.
The effects of cocaine and crack use are similar to amphetamines but more intense, the
effects of cocaine only last for up to an hour and crack wears off even more quickly. The
effects elevate mood, increase confidence and lead to feelings of exhilaration, alertness,
indifference to pain and fatigue. Large or repeated doses can cause agitation, anxiety,
panic, paranoia, nose bleeds, convulsions and hallucinations, which usually pass when
the drug is out of the body. The after effects can be fatigue and depression.
Though not physically addictive, users may develop a strong psychological dependence
to cocaine. After discontinuing use, the user may feel fatigued, sleepy and depressed,
which can lead to recommencement of use. It can exacerbate a pre-existing psychotic
condition.
21
Use during pregnancy:
Again, the effects are similar to those associated with amphetamines. However, links
have been made to developmental problems both before and after birth. The use of
cocaine in the last 12 weeks of pregnancy can cause uterine contractions and lead to
premature labour.
Cocaine can be found in breast milk causing babies to be irritable
and difficult to pacify. In extreme cases, the baby can have convulsions.
Ecstasy (Slang term: ‘E’)
Ecstasy comes in different coloured pills or capsules. The effects can give a feeling of
extra energy, a high that can make people very friendly and increase wakefulness.
Taken in large quantities, ecstasy can cause damage to brain cells, feelings of anxiety,
confusion and even paranoia. Ecstasy may also cause difficulty in sleeping and is
dangerous for people suffering from epilepsy or heart conditions. Females may find their
periods become heavier. The short-term effects of use are possible sweating, dry mouth
and throat and raised blood pressure. Water is not an antidote to ecstasy, excessive
drinking can lead to medical complications.
Use during pregnancy:
Ecstasy is derived from amphetamines and therefore, depending on the level of use,
problems may be similar.
Heroin (Slang terms: smack, brown, gear)
In its purest form, heroin is a white powder derived from the dried milk of the opium
poppy, when impure it can be brown in colour. It contains morphine and codeine, both
effective painkillers. Heroin can be injected, sniffed or smoked. The effects of use
include euphoric detachment, physical and emotional pain relief; small doses induce
feelings of warmth and contentment, higher doses induce feelings of sedation stupor,
sleep/unconsciousness that can last several hours. It is not uncommon for a first time
user to experience unpleasant side effects like nausea and vomiting. Tolerance and
physical dependency develop quickly with frequently repeated doses. On the street,
heroin is usually cut with other substances like glucose or talcum powder. Overdosing is
a big risk, leading to coma and possible death.
22
Use during pregnancy:
The only direct effect of opiate use during pregnancy is low birth weight although there is
some evidence of growth retardation in babies born to opiate using mothers. Heroin
does cross the placenta and there is a high possibility that the baby will experience
withdrawal symptoms after delivery, which will require medical intervention. Heroin can
be transmitted from mother to baby in breast milk and therefore can cause addiction in
the new born. Abrupt withdrawal from opiates during pregnancy is not recommended. It
is possible to switch to methadone and try and detoxify before the baby is born. If
detoxification is not possible then stabilisation on methadone is much safer.
LSD (Slang terms: acid, trips)
LSD usually comes on small squares of blotting paper, which come in different colours
and have a picture or motif on them. They are swallowed and take between thirty and
sixty minutes to take effect. The effects depend on the user’s mood and can last up to
12 hours. These often include distortion of vision/hearing or a feeling of being outside
the body. Bad trips can lead to depression, panic and even paranoia. The user may
complain of depression and anxiety for a few days. This will cease providing the user
does not take anymore. For individuals with prior history of mental illness LSD may
make the problem worse or indeed permanent. Other effects are hallucinations, memory
loss, flashbacks, risk of accidents and psychotic reactions.
Use during pregnancy:
Use of hallucinogens during pregnancy may complicate labour and delivery. Use during
breast-feeding could have devastating effects on a newborn baby.
Methadone
Methadone is a pain killer, similar to heroin and comes in tablet or liquid form (usually
green). It can cause physical dependence and is prescribed as a substitute medication
for heroin and other opiate type drugs in detoxification programmes. There are many
side effects such as itchiness drowsiness, nausea, vomiting, dry mouth and constipation.
Methadone can be highly dangerous if used incorrectly or by those for whom it is not
prescribed for e.g. children.
However under supervision and with clear instruction
23
around risks and safety precautions, methadone is an effective treatment. Information
leaflets for parents are available.
Use during pregnancy:
Problems with methadone are the same as other opiates, however, because prescribed
methadone provides a more stable opiate level in the body, it is considered the
treatment of choice during pregnancy. Methadone use during pregnancy may result in
agitation, poor sleeping and poor feeding in the newborn baby.
Low levels of
methadone may be found in breast milk and may help with withdrawal in the baby. A
supervised methadone detoxification is considered safe at any stage of pregnancy.
Solvents
‘Solvents’ includes glues, aerosols and gases (for example lighter fuel), the fumes of
which can be inhaled to get ‘high’. The effects last for about 30 minutes and the feeling
is similar to being very drunk. The effects of use can be an increased risk of accident
and death (for example, vomiting which unconscious), gases and cleaning fluids can
cause death through suffocation or heart failure. Long-term use can result in tiredness
and poor performance. There is possible lasting damage to the body (liver, kidney and
brain) however, this is rare.
Use during pregnancy:
There are possible links with reduce oxygen levels in the blood which can cross the
placenta and reduce the oxygen supply to the baby. There have been links with the use
of solvents in pregnancy and birth defects, miscarriages and growth retardation.
Steroids
Anabolic steroids are either swallowed as a pill or capsule and can also be injected into
a muscle. They are used by some athletes and body builders to increase muscle size
and aggression, and by others to improve appearance. They can cause stunting of
growth in those who are not yet fully grown. Constant use is potentially harmful as it can
raise blood pressure, increasing the risk of heart disease and strokes. Steroids can also
cause liver and kidney damage.
Psychological dependence can occur if the user
believes they cannot perform without the drug.
24
Over the counter drugs
These are identified as those, which are available without prescription from a pharmacy
or other retail outlet.
unnecessary
use.
It is important to distinguish between medicine misuse and
Some
people
take
vitamins
and
analgesic
preparations
indiscriminately, and it is an example of unnecessary use. Misuse refers to the use of a
preparation for a non-medical purpose in order to achieve psychoactive effects, for
example euphoria or altered body image, for example, weight loss.
Sometimes, over the counter drugs are used to ‘top up’ or augment the effects of an illicit
substance and occasionally they are used in an attempt to lessen or stave off withdrawal
symptoms or for self-detoxification.
Non prescription medications which are misused include:
Benylin, which can produce effects such as excitation, hallucinations, illusions, increase
perceptual awareness and hyperactivity. When chronically misused, discontinuation can
lead to withdrawal symptoms.
Opioid preparations such as Codeine Linctus, Kaolin and morphine mixture. These
substances are often used to supplement when other opioids are not avai lable.
Cough and cold products such as Day Nurse, Contac 400 and Beechams Hot Lemon.
These substances are misused to elevate mood, combat fatigue and as a substitute for
amphetamine to alleviate craving.
(Wills, 1997)
Associated Health Risks:
Injecting substance users are at particular risk of contracting HIV and Hepatitis.
HIV - can be transmitted in three ways;
1. Unprotected sex with an infected person.
2. Sharing needles or injecting equipment with an infected person.
3. From an infected mother to her unborn child.
25
Where parents are infected by HIV they may need additional support, to help care for the
children when they are ill.
All pregnant women, regardless of substance use status, should be given information
about HIV and the implications for the baby. It is advantageous to identify HIV infection
during pregnancy, however full assessment of risk taking and implications of the test
should be carried out with the client and screening only undertaken if the client consents.
This remains the choice of the woman and she should not feel pressured into having a
test.
Hepatitis - Hepatitis is a disease of the liver resulting from infection by a virus. There
are several types of hepatitis, the most common are:
Hepatitis A: the most common type in the general population, contacted from
contaminated food or water. The effects are usually less serious than Hepatitis B and C,
which are both common among injecting substance users.
Hepatitis B: is transmitted sexually or through sharing injecting equipment or household
objects like razors or toothbrushes. It is ten times more infectious than HIV, however a
vaccine is available.
Hepatitis C: is more prevalent among injecting substance users than either HIV or
Hepatitis B. It is transmitted in blood, i.e. by sharing injecting equipment, toothbrushes,
razors etc with an infected person. It is unusual for Hepatitis C to be transmitted by
other routes, however there is a low risk of vertical transmission. Unlike Hepatitis B
there is no effective immunisation against Hepatitis C.
Very few people will need
immediate treatment, though all should receive regular, long term monitoring.
26
Appendix 2
SCODA GUIDELINES ON RISK ASSESSMENT
The Standing Conference on Drug Abuse (SCODA) has developed guidelines for
Professionals Assessing Risk when Working with Drug using Families. This details
specific issues which will require consideration when undertaking an assessment of the
impact of substance misuse on a parent’s ability to meet their child’s needs. This Risk
Assessment Model identifies seven key areas, which require assessment.
Although the focus of the guidelines is on drug misuse, the assessment can be equally
applied to situations relating to alcohol or solvent misuse. These guidelines provide a
useful working tool for all professionals.
Consideration of All Factors:
It is important however to remember that parents with problems relating to substances
misuse should be assessed in the same way as other parents whose personal difficulties
interfere with or lessen their ability to provide good parenting. The assessment will need
as much emphasis given to non-related factors as to the particulars of parental
substance misuse. Substance misuse cannot always be separated from other aspects
of the user’s life, such as, health, poverty, employment and housing. Substance misuse
may lead to poor physical health or mental health problems, financial problems, housing
problems and breakdown in family relationships.
It is important to build up an individual profile of the parent, including their parenting of
any previous children and their own childhood experiences.
Many substance-misusing parents are children of users and therefore enquiries should
be made about any family history of addiction to either drugs or alcohol. This aspect of
the assessment may be therapeutic in sensitising parents to the emotional impact on
their own children of the substance misuse, by acknowledging their own childhood
experiences.
Substance misuse should not, on its own, be regarded as an automatic indicator of
abuse or neglect. Equally, parents who stop using substances should not necessarily be
assumed to be better or safer parents. The effects of withdrawal can have a severe
27
effect on the capacity of the parent to tolerate stress and anxiety. Each family should be
assessed on an individual basis.
Continuous Assessment:
It is important to remember that assessment is a continuous process. Once a parent
who misuses substances comes to the attention of any professional, the process of
assessment commences. It is dangerous to regard an assessment only as a specific
event. The very nature of substance misuse can lead to unpredictable situations and
rapidly changing circumstances.
All professionals have a responsibility to ensure that they continue to assess a child’s
situation, including an analysis of the degree of risk and the needs of the child on each
contact or receipt of any information concerning the child and his/her family.
Should it become apparent that the child is suffering or is likely to suffer harm as a result
of their parents’ substance use, Core Assessment will be completed as part of the plan
to protect the child (see Appendix 3). All professionals are responsible for this process
to ensure that all aspects of the children and their family’s circumstances are
considered.
28
GUIDELINES FOR PROFESSIONALS FOR ASSESSING RISK WHEN WORKING
WITH DRUG USING PARENTS
The Standing Conference on Drug Abuse developed these guidelines.
PARENTAL DRUG USE
1.
Is there a drug free parent, supportive partner or relative?
2.
Is the drug use by the parent Experimental? Recreational?
Chaotic?
Dependent?
3.
Does the user move between categories at different times? Does the drug use
also involve alcohol?
4.
Are levels of childcare different when a parent is using drugs and when not
using?
5.
Is there any evidence of coexistence of mental health problems alongside the
drug use?
If there is, do the drugs cause these problems, or have these
problems led to the drug use?
ACCOMMODATION AND THE H OME ENVIRONMENT
6.
Is the accommodation adequate for children?
7.
Are the parents ensuring that the rent and bills are paid?
8.
Does the family remain in one area or move frequently, if the latter, why?
9.
Are other drug users sharing the accommodation? Are they harmonious, or is
there conflict?
10.
Is the family living in a drug using community?
11.
If parents are using drugs, do children witness the taking of the drugs, or other
substances?
29
12.
Could other aspects of the drug use constitute a risk to children (e.g. conflict with
or between dealers, exposure to criminal activities related to drug use)?
PROVISION OF BASIC NEEDS
13.
Is there adequate food, clothing, and warmth for the children?
14.
Are the children attending school regularly?
15.
Are the children engaged in age-appropriate activities?
16.
Are the children’s emotional needs being adequately met?
17.
Are there any indications that any of the children are taking on a parenting role
within the family (e.g. caring for other children, excessive household
responsibilities etc)?
PROCUREMENT OF DRUGS
18.
Are the children alone while their parents are procuring drugs?
19.
Because of their parents’ drug use are the children being taken to places where
they could be “at risk”?
20.
How much are the drugs costing?
21.
How is the money obtained?
22.
Is this causing financial difficulties?
23.
Are the premises being used to sell drugs?
24.
Are the parents allowing their premises to be used by other drug users?
30
HEALTH RISKS
25.
If drugs and/or injecting equipment are kept on premises, are they kept securely?
26.
Are the children aware of where the drugs are kept?
27.
If parents are intravenous drug users:
Do they share injecting equipment?
Do they use a needle exchange system?
How do they dispose of syringes?
Are they aware of the health risks of injecting or using drugs?
28.
If parents are on substitute prescribing programme, such as methadone:
Are parents aware of the dangers of accessing this medication?
Do they take adequate precautions to ensure this does not happen?
29.
Are parent’s aware of, and in touch with, local specialist agencies that can advise
on such issues as needle exchanges, substitute-prescribing programmes, detox
and rehabilitation facilities? If they are in touch with agencies, how regular is the
contact?
FAMILY SOCIAL NETWORK AND SUPPORT SYSTEMS
30.
Do parents and children associate primarily with:
Other drug users?
Non-users?
Both?
31.
Are relatives aware of the drug use? Are they supportive?
31
32.
Will parents accept help from the relatives and other professional non-statutory
agencies?
33.
The degree of social isolation should be considered, particularly for those parents
living in remote areas where resources may not be available and they may
experience social stigmatisation.
PARENTS PERCEPTION OF THE SITUATION
34.
Do the parents see their drug use as harmful to themselves or to their children?
35.
Do the parents place their own needs before the needs of their children?
36.
Are the parents aware of the legislative and procedural context applying to their
circumstances (e.g. Child Protection procedures, statutory powers)?
32
Appendix 3
FRAMEWORK FOR THE ASSESSMENT OF CHILDREN IN NEED AND THEIR
FAMILIES (DOH 2000)
The Initial Assessment
A decision to gather more information constitutes an initial assessment. An initial
assessment is defined as a brief assessment of each child referred to social services
with a request for services to be provided. This should be undertaken within a
maximum of 7 working days. It should address the dimensions of the Assessment
Framework, determining whether the child is in need, the nature of the services required,
from where and within what timescales, and whether a further more detailed core
assessment should be undertaken.
The Core Assessment
A Core Assessment must be planned and co-ordinated. The gathering of information
requires careful planning to ensure that the assessment is comprehensive, child-centred
and does not subject the family to repeated assessments by different agencies.
Role of Social Services Directorate in undertaking the Core Assessment
The Social Services Directorate has a lead role in ensuring that Core Assessments are
undertaken. This involves planning, preparation and co-ordination with other agencies.
Planning for the assessment should include establishing the following:•
Who will be involved in the assessment, including family members.
•
Who will undertake which parts of the assessment.
•
Whether there are any communication difficulties and plans for how they will be
overcome.
•
Which questionnaires and scales will be used, and by whom.
•
What aspects of the assessment have already been undertaken.
•
Whether there are any sources of information about the child or his/her family not
previously contacted.
•
Whether the consent of the child’s parents has been given and, if not, how it will
be gained.
•
Where the assessment will be conducted.
•
How the information will be recorded.
•
Who will be involved in the analysis and how it will be done.
•
What the timescales are for each stage.
33
•
Whether any specialist assessments are required.
•
Who will undertake direct work with the child/children.
•
How family members and children will be involved in the assessment.
•
Whether the Core Group needs to co-opt any members who have particular
areas of knowledge and skill, e.g. drug and alcohol issues.
The Core Assessment should be completed within 35 working days of the end of the
Initial Assessment or from the strategy meeting/discussion that lead to a Section 47
enquiry.
Analysis and Judgment
The Core Assessment should be built on the integration of theory and practice. The
Assessment needs to be based on evidence. A decision can only be as good as the
evidence on which it is based.
Information should be gathered, collated and recorded in such a way that it leads into a
process of analysis. The Assessment should include clear summaries in which both the
strengths and the difficulties are identified in each of the 3 domains. Each domain is
subdivided into a number of dimensions (see diagram)
Assessment Framework
Health
Basic Care
Y
CIT
PA
CA
ING
NT
RE
PA
Ensuring Safety
CH
ILD
’S
DE
VE
LO
PM
EN
TA
L
NE
ED
S
Education
Emotional &
Behavioural Developmental
Identity
Family & Social
Relationships
Social Presentation
Emotional Warmth
Stimulation
CHILD
Guidance & Boundaries
Safeguarding &
Promoting
welfare
Stability
Selfcare Skills
FAMILY & ENVIRONMENTAL FACTORS
Family History
& Functioning
Wider Family
Housing
Employment
Income
Family’s Social
Integration
Community
Resources
Areas that may be useful to consider when completing Core Assessment on families
where parent(s) misuse substances.
i)
Developmental needs of child
Regular school attendance
Age appropriate activities
34
Are emotional needs met?
Evidence of children taking on parental roles
ii)
Parents capacity to meet child’s needs
Is drug use experimental/recreational/chaotic/dependent
Any changes in parenting and childcare with drug use
Any co-morbid mental illness
Are the bills being paid
Does the family move often, and if so, why?
What other drug users are sharing the accommodation and what is the
family’s relationship to them
Do children witness drug use
Appropriate stimulation (young children in buggies all day)
Adequate food, nutritional diet (the basic care of children can be
neglected if the parents primary motivation is obtaining substance or
money for substances)
Children left alone whilst parents obtain drugs or funding for drugs
Children taken to places where they could be at risk
Financing of, and diversion of family income into drugs (This can lead to
children living in situations of dire poverty and deprivation)
Accommodation being used to sell drugs
Premises being used by other drug users
Safe keeping of drugs and paraphernalia
Children’s awareness of where drugs are kept
Needle and syringe practices
Awareness of dangers of medication used in substitute prescribing
Precautions taken to ensure children do not have access to drugs
iii)
Family and Environmental factors
Any drug free support
Is accommodation suitable for children
Is the family living in a drug using community
Contacts with agencies advising about health risks and regularity of
contact with them
Family associations with users, non-users or both
Are relatives aware of drug use and are they supportive (Potentially
supportive family members might be excluded because of need for
secrecy)
Willingness of parents to accept help from relatives and agencies
Degree of social isolation
The Core Assessment should make judgements based on the analysis, including:
•
Whether the child is suffering or is likely to suffer continuing significant harm.
•
An understanding of the child and family’s context.
•
Whether there has been change or whether change is likely to be achieved.
•
The quality of the parent – child attachments.
35
•
The level of co-operation between the parents/family and the helping agencies.
•
The extent/level of any abuse.
•
Any protective factors within the family.
•
The ability of the family to engage in therapeutic work.
Decision Making
In drawing up a plan of intervention, it is important that there is an understanding of the
difference between judgements about the child’s needs and the capacity of the parents
to meet those needs, and decisions about how to intervene.
Decisions may include:
•
A package of support required to maintain the child at home.
•
Action required to reunify a child with his/her family.
•
Whether to further assess individual family members using specialist
assessments (e.g. psychiatric/psychological).
•
Whether to make application for a Court Order.
•
Whether an extended family member could care for a child where the natural
parent is unable to do so.
•
Whether to separate a child from his or her parent(s).
•
Whether to place a child with a permanent substitute family.
•
Any other action required to protect the child.
The Core Group should undertake analysis, judgements and decision-making and plans
should, wherever possible, be drawn up in agreement with the child/young person and
key family members.
Planning for Children
Plans for children should:
•
Have clear objectives.
•
Have a clear focus on the child.
•
Have achievable and reasonable timescales.
•
Contain clear statements about the purpose and roles of services and
professionals.
•
Be regularly reviewed and updated.
•
Contain details of alternatives to the plan if the objectives are not being met.
36